The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

June 17, 2010 #3,886 Publisher-Barry Block, DPM, JD

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All Flip-Flops Can Exacerbate Foot Problems: IL Podiatrist

Stability used to be a good thing in a shoe. But the current "fitness" footwear craze takes the opposite approach: By subtly throwing your body off balance, these shoes supposedly help you lose weight and sculpt muscles. For example, Fitflop Walkstar sandals contain what the company calls "muscle-loading micro-wobbleboard midsole technology" to engage your muscles for a longer period as you walk. But there's no rigorous evidence showing that they tone any better than other shoes or sandals.

Dr. Megan Leahy

In testing, we found Fitflop Walkstar sandals to be cushy and sporty, but difficult to walk in. In fact, podiatrist Megan Leahy warns that "all flip-flops can exacerbate foot problems due to contractures of foot and toe muscles during gait in a subconscious attempt to keep the shoe on."

Source: Julie Deardorff, Chicago Tribune [6/10/10]

NY Podiatrist Selected as Medical Director for Divas Half Marathon

Ed Fryman, DPM of Seaford, NY has been selected as the Medical Director of the Divas Half Marathon on Long Island this October. Dr. Fryman is also the Medical Director of the LI Marathon and Half Marathon where he has led a team of knowledgable medical professionals to provide top notch medical care for runners. 

Dr. Edward Fryman

Dr Fryman is the principal of Seaford Foot Care Center. He also serves as Medical Director for the Runner’s Edge Tobay Triathlon and Medical Adviser to the Massapequa Road Runners' Club.

WI Podiatrists Rock n’ Roll for Wheelchair Veterans

Podiatrists Dr. Bill Weis (Oak Creek, WI) and Dr. Isaac Trejo (Milwaukee, WI), joined by Tom Donovan and Scott Henry, provide entertainment for “Ride for the National Wheelchair Games” morning break. The Saturday, June 12 motorcycle ride raised money to send Wisconsin paralyzed veterans to the national games.

Dr. Bill Weis (far left) and Dr. Ike Trejo (far right) perform as Bushwood Rock n' Roll Band.

Weis and Trejo’s band "Bushwood" has been performing rock and roll cover songs and playing at local venues for the last two years. Trejo plays bass guitar and Weis plays lead guitar.

Surgeons, Nurses from Top Japanese Universities visit SALSA

As part of its mission, the Southern Arizona Limb Salvage Alliance (SALSA) routinely plays host to clinicians, worldwide. Rarely, however, does it host representatives from across an entire developed nation. This was the case today, when David G. Armstrong, Professor of Surgery and Director of SALSA, welcomed nurses and surgeons from across Japan, most notably from Tokyo University and Kawasaki University. "We always enjoy having guests in our SALSA bowl," noted Armstrong, "This visit, however, was particularly gratifying, as all clinicians wanted to immediately go back to their respective facilities to effect positive change."

Dr. Armstrong (front row, center) hosts a group led by Prof. Takahiko Moriguchi (front row, second from left) and Hiromi Sanada (front row, second from right) from across Japan.

In addition to touring the clinical facilities, guests visited the renowned cellular transplantation laboratory of Dr. Rilo to see conjoined SALSA projects there as well as the Arizona Simulation Technology and Education Center (ASTEC), which provides an unparalleled "virtual training" experience for physicians, surgeons, nurses, and emergency personnel.

Two and a Half Year Sentence for OH Podiatrist For DWI Accident

A podiatrist accused of causing a crash in Plymouth Township that left the other driver, a Canton Township woman, partially paralyzed will spend two-and-a-half years behind bars under a plea agreement reached Monday in Wayne County Circuit Court. Jason Choos, 46, also of Canton, pleaded no contest before Judge Daniel P. Ryan to six charges related to the Jan. 29 accident that injured Dawn Hengesbaugh, 41, the mother of two.

Source: Matt Jachman, Hometownlife.com [6/15/10]

Query: Single Screw for Scarf Bunionectomy?

I have been performing Scarf bunionectomies for several years and find the osteotomies to be very stable using two screws. I have had no toggling, troughing, or other movement. Has anyone used a single screw directed dorsal proximal to distal plantar (distal arm dorsally) in the standard Scarf osteotomy?

Art Hatfield, DPM, Long Beach, CA

Query: Medicare Compliance Program

How do I start a Medicare Compliance program? Where should I look for examples?

Noah A. Blumofe, DPM, Santa Monica, CA

RE: Traumeel as an Analgesic (Bob Kornfeld, DPM)
From: Elliot Udell, DPM, Michael Turlik, DPM

Would it be possible for Dr. Kornfeld to show how the dilute ingredients in Traumeel or any other homeopathic concoctions can cause the above changes in a patient’s physiology? I would expect that he reference his answers using well-respected physiology, biochemistry, and pharmacology texts used in our medical colleges. Using legitimate medical references is appropriate since we are being led by the manufacturers of these unscientific products to put our professional credentials on the line, when we either prescribe oral homeopathic products or inject them into human beings. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@Aol.com

I have never used Traumeel and do not know anything about it outside of what was described in the referenced article. I do not understand most of what Dr. Kornfeld has written, however, I would disagree with this statement, “I am not here to argue the "results." I think the results section is worth considering. The authors report¹ that the results of the intervention were not different than the control. There could be two explanations for this. The first is that there is truly no difference, or that because of the number of subjects enrolled in the study, a clinically significant effect may have been missed. This second explanation is referred to as a Type II error. Statistical significance is a function of sample size. Very large studies may report statistically significant results which are not clinically important or small studies may report non-significant results which fail to exclude a clinically important result.

Comparing and contrasting this study with a recently published study² evaluating the use of PRP in chronic Achilles tendoinopathy, both studies have taken adequate methods to minimize bias and both studies report that the intervention is not more effective than the control. Both studies describe a sample size calculation, however, only the PRP study specifies a clinically important difference. The results of the primary outcome in the PRP study are reported as a point estimate with 95% confidence intervals. Since the upper limits of the 95% CI do not contain the clinically important effect described in the methods section, it can be concluded that the study was adequately powered to detect a clinically important difference, and a Type II error has not been made. The Traumeel study reports only a P value, not a point estimate with confidence intervals. Therefore, a clinically significant effect cannot be ruled out, and a Type II error could have been made.

1 Singer, et al. BMC Clinical Pharmacology 2010, 10:9
2 de Vos, et. al. JAMA 2010;303(2):144-149

Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Ribotsky’s Inspiring Lecture
From: From: Marc Brenner, DPM

I recently attended a lecture by Dr. Bret Ribotsky. I found it to be highly informative and most inspiring. I've attached a link so that PM News readers can benefit from the ideas presented.

Marc Brenner, DPM, Glendale, NY, Icare4yourfeet@aol.com

RE: Winning a Malpractice Suit
From: Michael M. Rosenblatt, DPM

There are many steps you can take to win a malpractice suit, but in order to do that, you need to split the suit into different parts, because nearly every suit has more than one aspect to it. Almost all suits depend as much on what is in your chart as what actually happened to the patient. Most of us write chart notes defensively, but a better way of thinking would be that your chart note is not “private.” It can be legally viewed by as many as 50 to 100 people who are NOT your friends.
 
Splitting the suit into various aspects allows you to concentrate your thinking. Most suits allege improper or lack of consent, insufficient conservative care, excessive conservative care, lack of appropriate referral or consultation, improper or out-of-date surgical technique, improper post-op care, poor choice of procedure, etc.

In order to defend yourself, you should be thinking about every chart note you write, which will “answer” those issues long before you ever think you may go to court, since prevention is always the best option.  Almost all decently written charts are highly defendable. Never change a chart note.

After you’ve been sued, “compartmentalize” your thinking to defend yourself.  Allow yourself to “forget” about the suit during the day, but carry a notebook with you in case a great idea occurs to you, so you can write it down. Become an active part in your defense, because great ideas you have can save the day.  But you need to continue on with your life and practice. You deserve not to allow this to destroy you. 

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: The Super Group Practice Model - How Do I begin?
From: David Helfman, DPM
 
I have received many calls over the past year from physicians who ask me the same question: “I have a group of physicians who want to join together. We have spoken to some lawyers and consultants and it just seems that we are not all on the same page to make this happen?” As CEO and founder of Village Podiatry Centers, PC (40 locations, 7 surgery centers, an imaging center, a pathology Lab, and our own HBO wound care center), I can tell you that if you do it right, it can be done. The upside is unlimited if you all get aligned and avoid the traps that so many physicians have fallen into. Here’s an outline of the steps involved in beginning the process:

As a driven, passionate professional, you should be the catalyst for creating an ethical, team-based group practice utilizing cutting edge medical, surgical, and business skills to achieve optimal outcomes and a rewarding professional and personal life.

1. Assess the viability of the group model in your area to validate and ……

Editor’s Note: Dr. Helfman’s extended-length letter can be read here.

RE: Hardware Failure With Removal (Kenneth Meisler, DPM)
From: Kenneth Meisler, DPM

I am surprised at Dr. Poggio's response about a patient who required to be taken back to the O.R. when the fixation failed and the osteotomy displaced. He suggested billing it as an ORIF of a metatarsal fracture. I always thought that displacement of the osteotomy would be included within the 90-day global aftercare period of the surgery and should not be billed for under any code. I would appreciate the opinions of other billing experts.

Kenneth Meisler, DPM, New York, NY, kenmeisler@aol.com

RE: NY Podiatrist Lectures on Integrative Podiatric Medicine
From: Marc Katz, DPM, Bret Ribotsky, DPM

Kudos to Dr. Kornfeld for bringing podiatry into the future of medicine. My personal physician practices integrative medicine and I can tell you that this is thoughtful scientific medicine.  Treatments are individualized. For instance, we all are very different, so to make an assumption that we all need LDL under 70 makes no sense. There are so many other factors that need to be considered and then individualized treatments can be formulated.

I've read many books regarding integrative medicine. The physicians practicing this medicine are on the forefront. Most are MD's and DO's. Those treating cancer that use alternative therapies are often Ivy League graduates with Sloan Kettering training. These physicians understand that harm is caused by doctors who hand out a pill for every symptom without looking at the imbalance in the gut, neurotransmitters, hormones, etc. They used their brains and came to their own conclusions away from mainstream medicine because they saw the harm and ineffectiveness of many treatments.

Here is an example of such a physician. Dr. Eric Braverman is the Director of The Place for Achieving Total Health (PATH Medical). He also serves as Clinical Assistant Professor of Integrative Medicine at Weill Cornell Medical College (Cornell University). Dr. Braverman received this B.A. Summa Cum Laude from Brandeis University and his M.D. with honors from New York University Medical School, after which he performed post-graduate work in Internal Medicine with Yale Medical School Affiliates. So, we should all keep an open mind. 

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

Every once in a while there is "a day" that our profession can look back to as "a day" that our profession changed forever. One such day was when the first screw was put in a foot bone, or the day PM News published its first issue, or  the day when Suzanne Levine held the first seminar on aesthetic podiatric medicine...and now, last weekend when Robert Kornfeld taught his first "official"  seminar on integrative medicine on Long Island. 

While I was not around when the first screw was being placed, I was present for the others, and this past weekend's events and education will change our profession as all the above have. Dr. Kornfeld’s knowledge of holistic medicine and how its incorporation into treating pedal pathology was truly outstanding. The concept of understanding what was going on with a patient before a visit, and knowing how to treat the cause/mechanism as well as the problem, is something everyone should explore. From what I have learned, integrative medicine is very profitable for life, for value, and for your practice. Congratulations, Dr. Kornfeld, for sharing your over 25 years of experience.
 
Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

RE: Jaws 2010

With summer here, I thought my colleagues might be interested in seeing what can happen wading close to shore. Last week, my daughter-in-law was standing in 1-2 feet of water when she was bitten by a sand shark or barracuda. It latched on to her foot, but she was able to shake it off. 

Status Post Shark or Barracuda Bite

I had her transported by the paramedics to my local hospital where  after careful inspection, it was determined that there was no nerve or tendon damage. I stitched her wounds closed. From the pictures you can see both wounds and various teeth marks. All I can say is BE CAREFUL OUT THERE!

Barrett E Sachs, DPM, Plantation, FL

ASSOCIATE POSITIONS – TEXAS

EQUIPMENT FOR SALE – PODIATRY CHAIRS

2 podiatry chairs - used Midmark 117 and a Ritter 317. Great condition. $950 each Greenwich, NY Call:518-466-3287. Pick up only.

PRACTICE FOR SALE - MINNESOTA

Practice Grossing over $500K yearly. Good mix of surgery, orthotics, DME, diabetic care, general podiatry. Commute < 5 miles to work. Friendly Midwest lakes area with arts, good schools, affordable living, restaurants, shopping. Option to purchase building. Will consider associate to buy-in/ buy-out. Midwestpractice@gmail.com

CANADIAN PODIATRISTS COME BACK HOME!

An Edmonton, Alberta group of DPM’s requires an additional Podiatrist. Interest in biomechanics essential. Given Canadian visa restrictions, this position is open only to Canadian Citizens or permanent residents. Very attractive compensation package. Fax C.V. or letter of interest to: (780) 483-5796.

ASSOCIATE POSITION NORTH CAROLINA - ASHEVILLE/MOUNTAINS

Well established, multi-doctor, multi-office diverse practice has immediate need for associate doctor leading to partnership. Associate doctor will be very busy from day one. Attractive compensation and benefits. Buy-in potential after one year. Contact at smfc2@charterinternet.com or 828-734-1535

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-time 3-DPM group in South Bay of LA County. Minutes from best living in LA County. Practice is an excellent mix of surgery, general podiatry, diabetic care, and DME. Beautiful office with EMR, Digital X-ray and Orthoses, etc. Please e-mail cover letter, and resume to footcareone@verizon.net

PODIATRISTS NEEDED NATIONWIDE

Seeking a part-time or full-time podiatrists to provide podiatry house call and diabetic shoe fitting services to patients nationwide. We are a podiatry management company and have contracts with clients that have 1,000’s of established patients and all we need are hard-working good doctors to service them. We offer an excellent compensation package with benefits and the opportunity to build a fairly large practice very quickly. coasttocoastpodiatry@yahoo.com

EQUIPMENT WANTED – CR SCANNER

Reina 812 Manual CR Scanner in good condition. Contact: pmh@wffeet.com

ASSOCIATE POSITION – HOUSTON, TEXAS

Full-time, surgically-trained podiatrist needed for multi-office practice in Houston, TX. Ideal candidate must be motivated, dedicated and personable. Practice is a good mix of general podiatry and surgery, no nursing facilities. Must also be willing to do significant networking and marketing to help build the practice. Please e-mail cover letter, and resume to faajobs@gmail.com

PRACTICE FOR SALE – EASTERN OREGON

Recent poor health requires sale of busy 30+ year old practice in Eastern Oregon. Good mix of surgery and general podiatry. Pleasant community with year round outdoor recreation. Major metropolitan center 50 miles away. Current staff and doctor will stay on as needed. sparris@fmtc.com

PRACTICE FOR SALE – MAINE

25 year full scope in medical building, podiatrist friendly hospitals, appreciative and cooperative patients, excellent expansion potential, physician referrals. Wonderful place to raise a family. Retiring seller will stay for transition. mainefootdoc@yahoo.com

PART-TIME POSITION - NEW JERSEY

Available for a Board certified/qualified podiatrist. Located in Toms River and Manchester. We have a high-volume practice that treats routine care, trauma, sports-related injuries, hospital consults, and ER Consults. Possibly leading to full-time position for the right person. Please fax CV to (732) 349-0228 or email CV to njfeet@aol.com

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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